Related Experiment Video
Updated: Jul 29, 2025
Halogenated Agent Delivery in Porcine Model of Acute Respiratory Distress Syndrome via an Intensive Care Unit Type Device
Published on: September 24, 2020
Non-COVID-19 intensive care admissions during the pandemic: a multinational registry-based study
Joshua McLarty1,2, Edward Litton3,4, Abigail Beane5,6
1Alfred Hospital, Melbourne, Victoria, Australia j.mclarty@alfred.org.au.
Insights
The COVID-19 pandemic increased intensive care unit (ICU) mortality for non-COVID-19 patients globally. This rise was driven by middle-income countries, while high-income nations saw a decrease, highlighting global healthcare inequities.
Area of Science:
- Critical care medicine
- Global health
- Epidemiology
Background:
- The COVID-19 pandemic led to significant critical care admissions worldwide.
- International data on the pandemic's impact on non-COVID-19 intensive care unit (ICU) patients is limited.
- Understanding these effects is crucial for global healthcare preparedness.
Purpose of the Study:
- To assess the impact of the COVID-19 pandemic on mortality rates for non-COVID-19 patients requiring intensive care.
- To compare outcomes between 2019 (pre-pandemic) and 2020 (pandemic year) across different country income levels.
- To identify potential factors contributing to observed mortality trends.
Main Methods:
- An international retrospective cohort study was conducted using data from 11 national clinical quality registries across 15 countries.
- Non-COVID-19 admissions in 2020 were compared to all admissions in 2019.
- Primary outcome was ICU mortality; secondary outcomes included in-hospital mortality and standardized mortality ratio (SMR), stratified by country income.
Main Results:
- Non-COVID-19 ICU mortality increased from 9.3% in 2019 to 10.4% in 2020 (OR=1.15).
- Mortality significantly increased in middle-income countries (OR 1.25) but decreased in high-income countries (OR=0.96).
- Trends in hospital mortality and SMR aligned with ICU findings; COVID-19 burden did not solely explain these changes.
Conclusions:
- The COVID-19 pandemic exacerbated ICU mortality disparities among non-COVID-19 patients globally.
- Increased mortality in middle-income countries versus decreased mortality in high-income countries suggests significant healthcare inequities.
- Factors such as healthcare spending, pandemic response policies, and ICU strain likely contribute to these divergent outcomes.
Background:
The COVID-19 pandemic resulted in a large number of critical care admissions. While national reports have described the outcomes of patients with COVID-19, there is limited international data of the pandemic impact on non-COVID-19 patients requiring intensive care treatment.
Methods:
We conducted an international, retrospective cohort study using 2019 and 2020 data from 11 national clinical quality registries covering 15 countries. Non-COVID-19 admissions in 2020 were compared with all admissions in 2019, prepandemic. The primary outcome was intensive care unit (ICU) mortality. Secondary outcomes included in-hospital mortality and standardised mortality ratio (SMR). Analyses were stratified by the country income level(s) of each registry.
Findings:
Among 1 642 632 non-COVID-19 admissions, there was an increase in ICU mortality between 2019 (9.3%) and 2020 (10.4%), OR=1.15 (95% CI 1.14 to 1.17, p<0.001). Increased mortality was observed in middle-income countries (OR 1.25 95% CI 1.23 to 1.26), while mortality decreased in high-income countries (OR=0.96 95% CI 0.94 to 0.98). Hospital mortality and SMR trends for each registry were consistent with the observed ICU mortality findings. The burden of COVID-19 was highly variable, with COVID-19 ICU patient-days per bed ranging from 0.4 to 81.6 between registries. This alone did not explain the observed non-COVID-19 mortality changes.
Interpretation:
Increased ICU mortality occurred among non-COVID-19 patients during the pandemic, driven by increased mortality in middle-income countries, while mortality decreased in high-income countries. The causes for this inequity are likely multi-factorial, but healthcare spending, policy pandemic responses, and ICU strain may play significant roles.
More Related Videos
07:16An Educational Video Demonstration of How to Prone a Critically Ill Intubated Patient
Published on: November 30, 2022
10:38Observational Study Protocol for Repeated Clinical Examination and Critical Care Ultrasonography Within the Simple Intensive Care Studies
Published on: January 16, 2019
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:21Acute Respiratory Failure-II
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
01:30Acute Respiratory Failure-III
01:21Acute Respiratory Failure-I
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:30Acute Coronary Syndrome III: Diagnostic Studies